Symbrachydactyly is a congenital hand difference which is sporadic and generally unilateral that presents with shortened or absent central digits. The treatment of symbrachydactyly is multifaceted and optimized when opportunities to enhance innate ability through nonoperative interventions and surgical procedures are applied effectively. There is a significant, meaningful role for hand therapy, normalizing hand differences through hand camps or peer relationships, and, when appropriate, referral to mental health professionals. Surgical management is targeted at the associated features of symbrachydactyly including syndactyly, shortened first web space, short and/or unstable digits, and addressing absent digits.